Healthcare Inspectorate Wales concerns focus on the physical environment, finding that it is unacceptable for a medium secure mental health service. 

Healthcare Inspectorate Wales (HIW) has raised concerns about the care environment at Caswell Clinic, a medium secure mental health service in Bridgend, managed by Swansea Bay University Health Board. 

The clinic is based within Glanrhyd Hospital, where the wider estate is owned by Cwm Taf Morgannwg University Health Board.

Inspectors raised significant concerns about the physical environment, finding that the environment was unacceptable for a medium secure mental health service, and that it did not support safe, dignified and therapeutic care. Inspectors observed clear evidence of environmental deterioration both internally and externally, including water damage, damaged woodwork, temporary flooring repairs, and outdoor furniture and structures that were unsafe or in poor condition. The condition of gardens and outdoor spaces limited their therapeutic value, with escorted access required because of known hazards. 

These long-standing estate and maintenance issues increased infection prevention and control risks, placed additional pressure on staff, and reflected concerns previously identified through earlier HIW inspections and other external reviews.

“While we recognise that pressures associated with ageing mental health estates are not unique to Caswell Clinic and are evident in other services across Wales, this does not mitigate the impact on people receiving care at this service,” said HIW’s chief executive Alun Jones. 

Safety concerns

HIW said that it has since engaged with Cwm Taf Morgannwg University Health Board, which owns the Glanrhyd estate, and had received assurance that capital funding has been secured and responsibilities for remedial works clarified. 

These issues it said will take time to resolve fully, and it remains essential that patients are cared for in an environment that is safe and therapeutic.

Inspectors also identified inconsistencies in routine safety and security checks. These included gaps in records of emergency equipment checks, incomplete security checklists, and incomplete ligature alarm checks, particularly out of hours.

Two immediate safety concerns were escalated during the inspection and addressed at the time. Inspectors found that some bedroom observation panels had been covered, which reduced staff’s ability to observe patients. Inspectors also identified inconsistencies in the storage and accessibility of ligature risk equipment across wards, which could have delayed staff response in an emergency. This was raised with senior leaders, and immediate action was taken to improve storage arrangements and ensure the equipment was clearly visible and readily accessible.

Further areas for improvement included infection prevention and control issues linked to the environment, issues with laundry facilities, and reliance on paper-based records, which increased workload and duplication. Some patients said restrictions on mobile phone use limited their contact with family and support networks, which they felt affected their wellbeing and recovery. Inspectors also highlighted the need to strengthen staff training, improve communication and leadership visibility, and ensure learning from incidents and patient feedback is shared consistently across the service.